Report Introduction Elderly Care Nursing With Clients Cognitive Disorders: Dementia

1.        DEFINITIONS

Dementia is a clinical syndrome that includes hilagnya intellectual function and memory so that causes dysfunction of daily living (Brocklehurst and Allen, 1987)

According Lumbantobing SM (1997), dementia is defined as intellectual deteriorasikapasitas caused by brain disease

2.        Etiology

Causes of dementia has been made ​​a "mnemonics" as follows:

D: drugs (pharmaceuticals) for example: sedative, anti-convulsive penenangm, anti-depressants, and anti-hypertensive

E:   emosional (emotional distress, such as depression)

M:  metabolic and endocrine eg: diabetes, kidney disorders, liver, thyroid, and electrolyte

N:     nutrisioral, eg: lack of vitamin B1, B6, B12 and folic acid

E:     eye and ear (eye and ear dysfunction), for example: cataracts, conductive deafness

T:     tumors and head trauma

I:      infection, Mass: encephalitis, tuberculosis, and neurosyphilis

A: arteriosklerotik (complications of atherosclerotic disease, Mass infarkmiokard, heart failure, etc.)

3.        Pathophysiology

Dementia is a clinical syndrome that includes loss of intellectual function and memory / memory so severe that causes dysfunction of everyday life. Dementia can be caused by several things al infection in a long time, the use of excessive drugs, emotional increased, nutrients lacking in a long time, as well as severe head trauma. Infections and drugs are toxins in the body that can cause'm a gets into the blood vessels to circulate throughout the body including the brain, which then damage the brain cells.

              Emotional overload can also cause dementia, emotional when blood pressure will rise and when there is no treatment that will either lead to a stroke, a stroke on the state of the cause disturbances of motor and sensory function or other. While in a state of poor nutrition needs dala m lam a period of time will cause metabolic processes that affect the production of red blood cells and cause arteriosklerotik which can cause a stroke. In red blood cells decreased to disrupt the supply of O ₂ to the tissues of the body including the brain tissue that can lead to ischemic brain.

Dementia caused by severe trauma, it is the originator of the damage to brain cells that would lead to smaller brain volume and occurs degerasi neurons that would lead to disruption of brain function

4.        CLASSIFICATION

Classification of dementia according to R. Budi, 1999:

a.     Degenerative Dementia

Known as the Alzheimer type dementia is a condition include changes in the number, structure and function of neurons in certain areas of the brain cortex.

Clinical symptoms:

Phase I

Marked with subjective memory impairment, poor concentration, and visio-spatial disorder. Environment that used to be such a foreign, hard to find your way home usually take. Clients may complain of right and left agnosia. Even at this early phase of a sense of insight (insight) has been disrupted

Phase II

Occurs signs point to a focal-cortical damage, although not visible pattern typical deficit. Symptoms caused by parietal lobe dysfunction (eg agnosia, dyspraxia and akalkulia). Symptoms may occur neuorogi extensor plantar responses include da some facial weakness. Da delusions hallucinations may occur, although talks may still appear normal

Phase III

Conversation is interrupted by weight, may be completely lost. Kklien looks continuous apatik. Many clients do not recognize themselves or people he knew. With the progress of the disease, patients are often just lay in bed, either incontinence uri mupun Alvi. Often accompanied by seizures epile [PTIK grand mal. Severe neurologic symptoms showed severe disruption of motion step (gait), muscle tone and picture Kluver-Bucy syndrome mengarahpada (s apathy, ganggua introduction, uncontrollable mouth movements, hypersexuality, amnesia, and bulimia). The average length of the disease since the beginning of dianosis until death ranges from 9.3 years (between 8-15 years). Degenerative disease is a clinical diagnosis in which the diagnosis was made ​​by autopsy or brain biopsy

b.    Multi-infarct dementia

Is second only to Alzheimer's type. Senagai obtained due to sequelae of cortical stroke or recurrent subkoirtikal. Typical symptoms that appeared showed a decrease in multilevel (stepwise), diamana each acute episode showed a decrease in cognitive state. This situation lasted progressive, frequent examination by CT scan showed no lesions. With MRI detected more frequently.

c.     Dementia in neurology disease

Often occurs in Parkinson's disease, korea Huntington and hydrocephalus normal pressure. In a CT scan or MRI found ventricular dilation out of proportion compared to cortical brain atrophy similar to the symptoms of subcortical dementia also found symptoms posture and step (gait) and depression

d.    Amnestic syndrome and forgetfulness due to aging

The main symptoms are impaired memory (memory), whereas in dementia there is interference with the function of new intellectual terjadai usually causes are:

Ø        Thiamine deficiency (often due to excessive alcohol pemakaina)

Ø        Lesions in the brain structure of the middle temporal (due to trauma or anoxia)

Ø        Transient global ischemia (cursory) due to cerebrovascular isufisiensi

5.        Clinical manifestations

Early manifestations:

a.         Forgetful

b.         Tend to misplace items

c.         Repetition of words or deeds

d.        The ability to speak or socialize while still good

e.         Amendment when it continues on further aggravate the disorder, namely:

f.          Patients may not be able to work

g.         Not being able to recognize family

h.         Often lost

Psychological symptoms may start to look al:

a.         Depression

b.         Fear

c.         Can not be silent

d.        Apathetic

e.         Paranoid

Often these symptoms complained of by his family some of these symptoms may aggravate dementia and can often be controlled with medication

6.        Investigations

a.    CT Scan / MRI

     To ensure a brain hemorrhage, cerebral infarction single or multiple, location and magnitude of the presence of metastatic neoplasms

b.    EEG (Elektroencefalografi)

c.    Examination laboraatorium Leukocytes, blood sugar

d.   Arteriography

e.    Puncture lumabal

7.        MEDICAL MANAGEMENT

Drugs used:

a.         Depression can be given amitriptiline

b.         Anxiety can be given lorazepam

c.         Agitation, delusions may be given klorproma z in

d.        Insomnia can diberiakn prometazim

8.        HEALTH HISTORY

a.         Assessment of the medical history should include the normal pattern and behavior danperubahan including information about the time when they occurred

b.         Browse course of the disease accurately (mendaadak, gradually, gradial)

c.         Then and now includes the ability to perform daily activities especially tingakh self-care behaviors like fooding, toileting, bathing, dressing, and level of daily activity and attention in the past

d.        Past medical history

Ø        A history of drug use, alcohol

Ø        Emotional disorders eg depression

Ø        Metabolic and endocrine diseases

Ø        Dysfunction eyes and ears

Ø        Nutritional status is less

Ø        Tumor and trauma

Ø        Infection

Ø        Arteriosklerotik

e.         Physical examination

Cognitive function was assessed with now:

Ø        Observsi or measurement of orientation to time, place, and person

Ø        Expenditure and memory settings

Ø        The use of language

Ø        Ability to deal with problems

Ø        Mood / affective / emotional level

f.          For portable mental status examination (MMSE-PPSM (mini mental state examination))

g.          

List of Questions

Valuation

1.                  What is the date today? (Month, year) 2.                  What day is this? 3.                  Is the name of this place 4.                  What is the client's phone number?(When there is no phone home address) 5.                  How old is Mr / Ms? 6.                  when the father / mother born? (Date, month, year) 7.                  What is the name of our governor?(Headman / sub-district head / district) 8.                  What was the name before this governor? 9.                  Who is the mother's maiden name anada? 10.              3-3 Countdown, ranging from 20?

0-2 errors = good 3-4 errors = mild intellectual disorders 5-7 errors = impaired intellect being 8-10 errors = severe intellectual disorders Ø        If the patient is never allowed school kealahan value of values ​​above +1 Ø        If the patient is more ari high school gdiperbolehkan yan error -1 from above

REFERENCES

1.         Smeltzer, SC & Bare, Brunner and Suddarth's BG textbook of medical - surgical nursing. 8 ^th Edition. Rather language: Waluyo, A. New York: EGC; 2000 (the original book was published in 1996)

2.         Price, SA & Wilson, LM Pathophysiology: Clinical concept of disease processes. 4 ^th Edition. Rather language: Grace, P. New York: EGC; 1994 (the original book was published in 1992)

3.         Doengoes, ME, Moorhouse, MF, Geissler, AC Nursing care plans: Guidelines for planning and documenting Patient care. Rather language: Kariasa, IM Jakarta: EGC; 1999 (the original book was published in 1993)

4.         Textbook: Geriatrics (Elderly Health Sciences). Editor: R. Boedhi Darmojo, H. Hadi Martono. Jakarta: Hall Publishers FKUI; 1999